| The role of PI3K/Akt signal pathway in ulinastatin postconditioning-induced attenuation of apoptosis in lung after deep hypothermic circulatory arrest in rabbitsObjective To investigate the effect of PI3K/Akt signal pathway in ulinastatin post conditioning-induced on apoptosis in lung after deep hypothermic circulatory arrest.Methods New Zealand rabbits(n=18)whose ages were about 15-20 weeks and weight were about 2.8-3.9kg,were randomly divided into deep hypothermic circulatory arrest(DHCA)group(n=6),DHCA+ ulinastatin group(n=6),control group(n=6).The deep hypothermic circulatory arrest model was founded after anesthesia,with right axillary artery and right atrium were intubated to arterial perfusion and venous drainage and cardioplegia was perfused into heart by cannula after purse string suture at aortic root.Rabbits in control group open the chest and operate the intubation as the fake operations after donating bleed.The lungs were obtained after fake operations at once.The rabbits' body temperatures of DHCA group and DHCA+ ulinastatin group were cooled at the range of 19?-20? under the cardiopulmonary bypass and then stop the pump make the rabbits stay at the stop-circulation state for 1 hour.After that process,the pump was open and the rabbits' body temperature were increased to 30°C and get the heart rebeating under the cardiopulmonary bypass.At this moment,ulinastain was infused into rabbits' body by the return chamber.The lungs were obtained after lhour observation.The ratio of lung wet-to-dry weight were measured after drying.The HE staining and TUNEL staining were performed to reflect the tissue pathologic change and measured the apoptosis index.Western blotting detected Akt,p-Akt,Cyt C and caspase-9 protein levels of lung tissues.Results The ratio of lung wet-to-dry weight exist statistical difference between control group and DHCA group and DHCA group and DHCA+ ulinastain group.And the HE staining results showed that the injury of DHCA group were severe,with the injury of DHCA+ulinastain group were relatively slight after observation by optical microscope.The apoptosis index results exist statistical differences,which is DHCA group is higher than DHCA+ulinastain group and higher than control group.The results from western blot show that the level of p-Akt protein expression increased and the level of Cyt C and Caspase9 protein expression declined.Conclusions Ulinastatin postconditioning-attenuation of apoptosis in lung and alleviate the lung injury caused by deep hypothermic circulatory arrest.And its mechanism of attenuation of apoptosis is associated with PI3K/Akt signal pathway.Objective Evaluate the early-term outcomes and analyze the risk factors for delayed recovery of intensive care unit after total correction of adult tetralogy of Fallot(TOF).Methods 165 patients' preoperative and postoperative clinical data of total correction of tetralogy of Fallot from a single medical center were collected,whose operations were made between June 2011 to June 2016,to evaluate the operations' early-term outcomes.According to the different length of ICU stay,all 165 patients were divided into two groups.In the prolonged stay group,there are 40 patients whose ICU stay was over 75th Percentile of ICU stay and the other 125 patients were divided into the normal stay group.What is compared between two groups is relative parameters included demographic parameters,patients'preoperative hemoglobin concentration,patients' preoperative platelet count,patients'preoperative blood albumin concentration,patients' preoperative blood urea nitrogen concentration,patients' preoperative serum creatinine concentration,patients,left ventricular end-diastolic volume index(LVEDVI),patients' left ventricular ejection fraction(LVEF),patients' size of ventricular septal defect(VSD),patients,degree of aorta overriding and the exist of combination with atrial septal defect(ASD),patent foramen ovale,patent ductus arteriosus(PDA)and malformation of coronary artery.Simple correlation and logistic regression were used in this study.Results There were 3(1.82%)patients' deaths postoperatively during the hospitalization with the other patients were discharged from hospital after recovery.13(7.88%)patients' early postoperative complication occurred and the average postoperative ICU stay time was(2.32±2.35)d and hospitalization time was(15.81 ±8.43)d.Simple correlation showed that the patients' preoperative platelet count((159.28165.01×106/L)and left ventricular ejection fraction(LVEF)((61.55±7.77)%)were significantly lower in delayed recovery group than those in control group((70.10± 13.25))gmol/L,(183.21 ±64.50)×106/L,(64.46±6.91)%)(P<0.05).The cardiopulmonary bypass time((189.21±95.82)min),aortic clamping time((134.93±52.69)min)in delayed recovery group were significantly longer than those in control group((146.08±47.12)min,(107.62±35.62)min,(P<0.05).The other parameters were obtained the negative results.Conclusions Safe and efficacious early-teram postoperative outcomes of phase I total correction for adult TOF patients can be obtained. |
PDF Full Text Request